Is the precise control of circulating heparin levels during cardiopulmonary bypass beneficial in paediatric open-heart surgery?

Objectives

Despite careful monitoring of anticoagulation during cardiopulmonary bypass (CPB) by means of activated coagulation time (ACT), thrombin generation does occur at variable rates, initiating several pro-inflammatory reactions. The mechanisms responsible for this activation of the coagulation cascade include inadequate heparinisation, often masked by hypothermia and haemodilution. The objective of this study was to compare the effects of two methods of managing anticoagulation during CPB in infants and children.

Conclusions

Management of anticoagulation during CPB aiming to achieve and maintain an [Hep] significantly higher than 'normal' results in less activation of the coagulation cascade, lower fibrinolysis, and lower blood losses and need for tranfusions. Further studies, on a larger number of children, are warranted to better define the clinical impact of these findings.